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AN JOAO4JIN CQ1N17 PVRIIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> • UROERGRCUNO STORAGE TANK PROGRAM • FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> FI <br /> A TY OF STOCKTON, SWENSON GOLF COURSE JIM ESCOBAR <br /> C109) 4aa S E PHONg� Nlt AREA CODE <br /> L btS� <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> - <br /> M TRANSFER FEE • 520.00 UNAUTHORIZED RELEASE EVALUATION • S5J.OU/hr 5 <br /> I <br /> S <br /> C CONSULTATION FEE f53.00/hr SAMPLING INSPECTION FEE • 553.00/hr S <br /> TOTAL DUE S 159709 <br /> OFFICE USE ONLY <br /> :�'y"'n:::^�,,,.�:��S�rr•,::,:..rr+wr•...r.,.,.w.,...rr...wrr.r....r wrw wu rwwwrr•wwr•wwrwr ww r.wrriwrr <br /> wmi6dr NM(�9 Tt>2' -rSrC 'blull>'Ta1�L '• /t. 11 '�C� wwwr � ��1 `R i <br /> a 7 q R <br /> 1 ' <br /> mr wwwrwrwrraw baa ww.w mwin aw wr m.wmww.mm.v mmw mrw Arwrw�sllw u/A'/�++'aM wAw arww rlwwrww <br /> EN 23 052 (REV 4/8/91) 1t Pane 11 <br /> d"dl:'►i.'a"wr kF`.•: °;4 `Ic*'�N• <._ <br />